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POLICY: Grace-Marie Turner podcast transcript.

I know a lot of people don’t like podcasts and the one I did with Grace Marie Turner from Galen back in April was both fascinating and recorded in a painful way to listen to. So now I’ve found CastingWords who do excellent transcripts for relatively little money, I’ve had this one transcribed. My original comments and the podcast are here. Read enjoy and comment away

Matthew: So I’m talking with Grace-Marie Turner. Grace-Marie is the president of the Galen Institute, which is a think-tank based in the Washington, D.C. area which has been very vocal on the consumer directed healthcare and HSA side. She is also taking part in a consumer directed healthcare conference coming up in San Francisco, and as part of that, I thought it would be fun to interview her. So Grace, welcome to our THCB podcast. How are you today?

Grace-Marie: Thank you. I’m fine. Delightful to be with you.

Matthew: OK, so let me start off. As you know, people of different political persuasions are reading a lot of different things into the early data that’s coming back from the consumer directed health plans, HSA, HRA, high deductible health plan movement that’s going on. And there are people with different political persuasions looking at the same data in different ways. So I don’t want to get too much into the mire of that, but I’m interested in the philosophy behind why you think that a consumer directed high deductible health plan is a good thing for the nation as a whole. So I’d like to get your take on that, and then I have some questions around how this thing how it works in theory rather than practice. So in general, why are you a supporter of this movement?

Grace-Marie: All right. First of all I’m not sure that it’s the right thing for the country as a whole, but I think that there are millions of people out there who are truly shut out of the health insurance market that find health savings accounts an attractive alternative……

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PHYSICIANS: Ed Goldman podcast transcript

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This is the transcript from the interview/podcast I did with Ed Goldman from MDVIP a week or so back. (The transcript was done very well and very affordably by castingwords. I just gave it a light readability edit)
Matthew Holt: So this is Matthew Holt from the healthcare blog and I’m doing yet another podcast and this one is from Ed Goldman president and CEO of MDVIP. MDVIP is a concierge physician franchise company which is helping physicians setup in the concierge market. Ed is it correct to say you’re a retired physician or are you still practicing?

Ed Goldman: No I’m a full time administrator these days.

Matthew: Ed has crossed over to the dark side but is doing something that is very interesting. Those of you who have read the healthcare blog know I’m not a big fan of multi different tiers of medicine—I’m all for universal health insurance and all the rest of it. You may wonder why I’m featuring someone from the “other end”. The reason is I had a conversation with Ed a while back in doing some private consulting work. There were some really interesting outcomes and approaches that MDVIP is using. So Ed a) thank you very much for agreeing to coming on the podcast and b) why don’t you give me a touch about the background of MDVIP how you work with physicians where you are as an organization and a little bit about how you got into this just a little bit of introduction I don’t know much about the company. 

 

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THCB: Fame and fortune and everything that goes with it….

I’ll be on a panel with Dimitry, Amy Hughes from Cisco and several non-bloggers talking about new media, blogs, podcasts, etc, etc in healthcare

Date: Thursday, September 28, 2006Time: 8:00 a.m. to 10:00 a.m. (includes light breakfast)Location: Jack Morton, 560 Pacific Avenue, San Francisco, CA 94133

For more info see here. It’s slanted towards PR. Which as you know is the world’s most important industry as those things that are perceived to be real are real in their consequences…..

POLICY: You can be a Nobel laureate and still be very confused

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The NY Times has a fairly jaw dropping article which basically says that whatever we spend on health care, it’s all good! It basically goes down the David Cutler/Mark Pauly line of “we wouldn’t spend all that money if the free market wasn’t working, and so the real outcome is the economically best outcome.” And it has this gem of a quote from a Nobel laureate, and this guy, unlike a rather more interesting Nobel laureate Kerry Mullis, is not copping to hallucinogenic drug use

By 2030, predicts Robert W. Fogel, a Nobel laureate at the University of Chicago Graduate School of Business, about 25 percent of the G.D.P. will be spent on health care, making it “the driving force in the economy,” just as railroads drove the economy at the start of the 20th century. Unless the current system is changed, most health care costs will continue to be paid by insurance, especially Medicare, which means that the taxpayers will foot the bill. But Dr. Fogel says he is not alarmed. Americans can afford it, he says, because the nation is so rich.

Now there is a huge difference between “we can afford it” and saying that it’s the driving force in the economy like “railways”. Thinking back to your high school economics class, you were taught that there were two types of economic activity—those that assisted in making stuff (usually called “manufacturing”) and those that didn’t directly assist in making stuff (“services”). Railways (and telecommunications and power and all the other utilities) are infrastructure that directly assist in the support of making stuff, usually by allowing producers to access new markets, and those markets to access new producers. That’s basically the logic whether it was railways opening Kansas wheat fields to East Coast markets, or the Internet allowing American software companies to access Indian programmers.

Health care, though, is a consumption good. Despite David Cutler’s best efforts it’s a total stretch to imply that the delivery of more health care results in more “health” — in fact the Wennberg group has pretty conclusively shown that the reverse is true (as Vic Fuchs showed over the years). Additionally “health care delivery” doesn’t have much to do with the improvements in health for the younger (productive) population overall that we care about—that’s down to better sewers, clean drinking water and immunizations. But beyond that it’s also a fallacy to suggest that greater “health” has the impact that railways or fiber-optics have. Better health for a start doesn’t directly impact production, and the marginal amount of better health we are creating via increased use of health care services is largely concentrated amongst those who have retired and are consuming society’s resources not adding to them.

So the extra spending on health care, as Fuchs points out in the article, is both discretionary and a redistribution of wealth from the young to the old (or actually to the industry that provides those services to the old):

Victor R. Fuchs, also an economist at Stanford, notes that buying health care is fundamentally different from buying a television or a car. “Most of it involves transfers from the young to the old,” he said. “Down the road, most medical care will be for people over age 65, and most of the payments will be from taxes on younger people.”

So if it’s discretionary, most health care spending is not for the equivalent of infrastructure or productive capacity, it’s for marginal consumption—meaning that health care is not like the railways, instead it’s just like the Frappachinos I told you all about last year.

But the best line is Cutler’s. When asked about more spending,

He added, “Are you willing to do that? Yes, it costs a lot, but we’re rich enough where the alternative use of the money isn’t as valuable.”

That one wins today’s Mark Pauly award for blind economic idiocy. Cutler seems to think that we’re spending money on health care because we want to. There’s clearly no chance that the actors in the system have somehow captured the body politic to ensure that ever growing health care spending is the result. No, no chance of that at all. After all health care is a pure free market Adam Smith would love–yes it is!

And then given the total lack of problems this nation and the world faces, spending our marginal resources on more flat of the curve medicine is by definition the best way to allocate resources. I for one can think of no better possible recipients for the money.

JOBS: Wanna go to the middle east?

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No, I’m not offering a one-way trip to Baghdad. This sounds a whole lot better. 

A colleague in the recruiting world is looking for 3 senior nursing directors and 3 medical directors to work in the United Arab Emirates. Salaries (not including a whole lot of ex-pat benefits) are around $93,000~$142,000 for the nursing directors and $351,000~$547,000 for the medical directors. First $82,400 is tax free, worth around $25,000 ($82,400 * .3 tax bracket). If you’re interested ship me a resume and I’ll put you in touch.

Sadly I have no RN or MD degree…..

HEALTH PLANS: Roy Poses keeps up his attack dog tactics

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Roy Poses at Health Care Renewal keeps up his attack dog stance on the United HealthGroup board. Although I can’t exactly agree with all of his criticisms—for instance Mary Mudlinger’s attempt to increase the use of NPs is probably a good thing—he is the only person out there pointing out the inherent difficulty for academics being on a corporate board that has, at the least, potential conflicts of interest with their academic missions.

Of course the real dirt is that the UHC board including McGuire contributed to Thomas H. Kean’s son’s political campaign while Kean (the ex-NJ governor and chair of the ineffectual 9–11 commission) was on the compensation committee. Yup, that committee which agreed with the options backdating (or at least had it happen on its watch).

Anyway, I’m glad Roy’s on this, so I can slack off!

PHYSICIANS: Patient comments on overuse

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The NY Times asked. Have you ever suspected that a physician had financial incentives for recommending a medical treatment to you? One day later they have 236 comments from readers. almost all uniformly going after doctors and dentists for overtreatment.  If you think some TCHB regulars are susicious of doctors…well they’ve got nothing on this bunch!

Meanwhile I have a gem of a story about psychotherapists overcharging desperate parents that I’ve been dragged into which I’ll share with you later.

The Industry: Worth a look By John Irvine

Today contributor John Irvine reprises his role at FierceHealthcare with a guided tour of some of last week’s top healthcare stories. Go have a read and I’ll be back tomorrow  with more.

The FBI’s Upgrade that wasn’t

Five years ago the FBI announced it
would spend $170 million upgrading the paper filing system it had used to track cases and suspects since J.
Edgar Hoover’s day. The result was the Virtual
Case File (VCF) a snazzy system developed by SAIC that looked as though it
was going to solve everybody’s problems. There was only one thing: the Virtual
Case File produced an error rate that was one of the worst experts had ever
seen. A year later the project was
dead. The Washington Post takes a look back at a debacle that may have helped
set the stage for the intelligence failures leading up to September 11 and
assesses SAIC’s responsibility for the project’s failure.

Annals of Generic Medicine

It is beginning to look as though
the Plavix debacle could cost Bristol–Myers
Squibb CEO Peter Dolan his job, the Wall Street Journal reports. The company’s board pointedly chose not to
“reiterate previous statements of support” for Dolan last week. By allowing the
right to produce the blockbuster to
slip into the nefarious hands of another unscrupulous generic drug maker in a
lawless and faraway country (Canada), Dolan has cost his company dearly, the doubters say. How dearly? Dearly indeed. According to some
estimates, the loss of Plavix could BMS cost $3.8 billion, more than a third of
its revenues.

Fast times at the Cleveland Clinic

The Cleveland Clinic is “severing” its relationship with the
cardiologist who has led its technology transfer and commercialization division
since October 2005. The Cleveland Plain Dealer reported on Friday that an
internal review found that Dr Jay Yadav failed to disclose his continuing
involvement with Angioguard, a stent
company he sold to Johnson & Johnson before joining the hospital system. The Clinic has faced heat over its conflict of interest policies since a
Wall Street Journal story last year focusing on its relationships with outside
investors. According to the Plain
Dealer, Yadav continued to receive 1 % of Angioguard’s annual revenues even
after joining the healthcare system, as the inventor of Angioguard’s key
product.

Great moments in Cardiology

The Plain Dealer story on Yadav
includes mention of a classic snippet
of healthcare history most people don’t know about, describing how the owner of Fuddruckers, known for its giant
burgers and massive artery clogging portions of various fried delacies, helped finance research on the
first commercially successful stent in the 1980s. Critics argue that isn’t a coincidence that a maker of a popular
product known for its artery clogging ways helped fund a medical device used by
cardiologists to prop them open again. Hamburgers? Stents? By god, there really are conspiracies everywhere you
look.

Java for Java
In the past, it has often taken
weeks for reports of new cases of bird flu to make it to Jakarta from outlying
provinces. With Indonesia one of the most likely places for an influenza
pandemic to gain strength, that’s simply not good enough say critics. The Wall Street Journal reports that In October Indonesian authorities will test
a reporting system developed by D.C. based Voxiva that allows health
workers to send reports of suspected
H5N1 infections to Jakarta with their cell phones using text messaging. Those using Java enabled phones will be able
to input information directly into a database. Instead of relying on incident reports tallied by officials in Jakarta
on a monthly basis, supervisors will be able to call up a real time map showing
outbreaks. Very cool. And probably not a bad idea, either. 

Eye on Elyria

Unless you’re from certain parts of
northwestern central Ohio, you probably haven’t heard of the small town of Elyria, which sits a little bit to the
left of Cleveland on the map. Officials at the Centers for Medicare and
Medicaid Services apparently hadn’t either: at least until recently when
somebody pointed out that the rate for angioplasties in Elyria is about three
times the national average. A little
swift detective work by the New York Times traces the odd little statistical
anomaly to its source: the dedicated cardiologists at the North Ohio Heart
Center. Another example of doctors
guiding patients towards more lucrative procedures or simply an outlier? Critics
argue the former. Nay, say the cardiologists, we’re simply being aggressive.
Could we have another Redding Medical
Center on our hands? wonder the fine folks at the NYT.

O Canada, Part II

Even Ronald Reagan, a reluctant
supporter of the AIDS cause, managed to make it. Critics are demanding to know why Canadian prime minister Stephen
Harper, a critic of both needle exchange programs and gay rights, refused to show up for last week’s AIDS
Summit in Toronto, citing – of all things – a previous commitment to visit the
arctic circle. Instead of announcing his government’s new AIDS policy to
assembled scientists and activists in Toronto, Harper chose to be off
inspecting igloos.  Activists say Harper wants to dodge tough questions on his
decision not to extend
funding for a legal safe injection site in Vancouver that researchers say has
helped cut the incidence of new infections.

Sorry we can’t hire you, your genetic profile says you’re likely to be a heavy Myspace
user

A new Wall Street Journal/Harris
Poll finds strong support for allowing health care providers, law enforcement
and personal use of genetic information gathered from DNA tests. Most of those
surveyed were a little less enthusiastic about allowing insurers or employers
access to the data. Only 14% say they approve of allowing insurers or employers
to have access to information about their genetic profiles. Oh, and ninety
three percent of Americans think the science of genetics is a “good thing.” One
percent find the concept “evil.”

We report you decide. You report we decide. Or something …

On Friday New York Governor George Pataki signed a bill that
extends a $10,000 tax credit to New Yorkers who sign up to beome live organ
donors. Supporters say a similar
national law could help end the shortage of available organs. Is this a silly and ethically repugnant
solution to a pressing problem, like Arizona’s plan to encourage voter participation by making voters eligible for a $ 1 million
dollar prize or a clever market-based way to bribe the masses? We report. You
decide.

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